Autism, Meltdowns, and Sherlock Holmes

“When you remove the impossible, whatever remains, however improbable, must be the truth.” – Sherlock Holmes

Meltdowns – or perhaps we should call them ‘strongly, vocally, and dramatically expressed opinions’ – have become an all-too-frequent occurrence around here lately. I’ve read many posts and heard many stories from parents of autistic children talking about their kids just falling apart in some situations and the frustration and anguish those parents feel in trying to figure out why and what they can do about it. Previously, I’ve listened more as an interested conversation partner, parent of an autistic child, and friend, and I’ve also been thankful that this issue hasn’t much been a part of our lives.

OK, you can welcome us to the club now.

I started writing a post days ago on the stories from this past week, but every day things kept changing. Writing about all this became like throwing a Lego and trying to hit a speeding bullet. So let me take one particular episode and describe it, particularly because it illustrates how we figured it out. And in this case, the remarkable thing to me is that the J-Man and I primarily are the ‘we’ here. We discovered the solution together, and I’m quite proud of that.

Everybody here has been sick at some point or another this week with terrible colds. My head feels like a basketball someone is pumping up with an industrial air compressor. The J-Man has had similar-sounding congestion and an ugly-sounding cough these past couple of days. Dale Jr. has a nose that runs like a fire hose, and he refuses to nap. Mary is the least symptomatic, but also probably more exhausted than everyone else combined. All that is to say that everyone already had plenty of reasons to feel like dirt and have whatever meltdown they wanted to.

The specific meltdown I wanted to write about came later this week during the bedtime routine. We’ve kept the same routine for a long time with nary a problem for months. All of the sudden, he started to completely freak out during teeth brushing. I’d try to brush some more but he just became more and more apoplectic. You could see the desperation dialing up in him.

As a rule, if we keep the same routines in certain situations, that gives us a fairly finite set of things we can check for potential meltdown-causing issues. Bedtime is pretty simple and unchanging in our house. He comes upstairs, goes into the big bathroom, I take his shirt off, give him his pill, and then give him his two liquid meds. He went through these just fine as he has for ages. Then I brush his teeth, first with his toddler toothbrush with non-flouride toothpaste and then I ‘rinse’ out his mouth using a wet washcloth that I run around in there with my finger. I barely got the brush in and one or two passes on some teeth before he became frantic.

He walked out of the usual corner he hangs out in while he gets medicine and teeth brushed and instead went over to the toothbrush holder on the bathroom counter, which he never does. He started grabbing at his old toothbrush, which we had retired before our recent trip (without ever throwing it out I’d just noticed) but that he never seemed to much care about. I finished his teeth as best I could with him screaming and thrashing, and we went to his bedroom, where he remained either thrashing and hysterical or trying to get out of the room for a good half hour.

One thing to know about the J-Man is that when something like this goes wrong, he feels compelled to go back to the meltdown point (that specific thing he was doing at the moment it happened) and essentially start over, like rewinding the tape and recording again from the point the scene got messed up. In certain instances where it’s not that disruptive or is otherwise not a big deal, we’re fine with hitting the reset switch. But this isn’t a habit we think should be fed every time it happens.

In this case, he was trying to go back to the bathroom to fix something. But I was in a mood where I didn’t feel like participating in this flashback, especially since similar behavior had occurred at school this week and we were taking a fairly hard line in working through it. Finally we got him to bed and Mary and I did our normal “What the hell happened?” debrief, but we were completely clueless. The leading possibility at that point was that in the past he’s been unhappy with teeth brushing when he has a cold because his sinuses hurt. Seems logical to me, but this went way beyond that. Had to be something more.

This happened again the next night, this time with him searching all over the sink for something and not finding it. He was terribly upset and, already overwhelmed with many other issues this week, I was just lost and frustrated and angry and pretty close to over the edge. We got him into bed more quickly, but the whole thing was still a debacle.

The next night, braced for Round 3, I stumbled across what seemed like the answer. Really, though, I stumbled on it because we’d been trying to dissect every part of the routine that could have triggered it. This is where Sherlock Holmes becomes a dear friend to parents like us. While eliminating something as ‘impossible’ is something you learn is pretty much itself impossible where autism is concerned, we try instead to first eliminate consideration of things that are constant and have been happening in the same way for a long time. It’s almost always variance in that routine that’s the culprit.

“He’s not feeling well” is a variance from normal, obviously, and this can cause sensory issues to become much more pronounced just by itself. But we know better than to write anything off as “he’s just feeling sick” as that doesn’t really get us far enough into understanding the full meltdowns. If it wasn’t anything leading up to the teeth brushing that had changed, what was it about the brushing that was the issue? It was the same toothbrush we’d used for a couple of weeks. He started the routine standing in the place he always does (before he ran to the sink to look for something). Everything else in the bathroom environment was the same. Nothing seemed different to me, and by now we’ve learned to keep a comprehensive database of variables in our head just for instances like this.

He let me start to brush his teeth that next night. And then almost like a vision, it came to me – something that wasn’t normal; I didn’t see the usual amount of foaming of the toothpaste in his mouth. Toothpaste was on there, but the baby/toddler toothpaste doesn’t have much to it anyway. He interrupted the brushing, went over to the bathroom sink again, still unhappy but more composed, and finally found what he had apparently been looking for before – the small tube his toothpaste comes in.

“Do you need more toothpaste than Daddy put on there?” He handed me the tube and pulled my hand toward the toothbrush, which was in my other hand. Communication link established! “OK. I’ll put more on.” And he walked back to his corner. I heaped it on there pretty good, brushed his teeth, got some good toothpaste foam going, and everything was back to normal in the bedtime routine.

So, the answer – toothpaste, specifically the amount thereof. Who would have imagined?

After that success, I still thought, “No way. It was the toothpaste?” But we had looked at the pattern, eliminated all the other variables, and realized that the remaining one, no more how ridiculous it seemed in comparison to the severity of the meltdown, was the answer. And really, it’s not that ridiculous. The toothpaste is flavored, and if you’d had several days of coughing and sinus drainage, some fruit-flavored anything – not to mention the accompanying teeth brushing – would make your mouth feel and taste better. This was understandably important to him for us to work out.

I’m really proud of this moment. Two people who couldn’t figure out how to communicate and meet this important need discovered a way to do just that. How? By continually looking for ways to uncover the answer, and at least for me, analyzing the routines, patterns, and possibilities until the answer came. That’s not to say that anger, frustration, exasperation, and a few other -tions weren’t part of all that for me, because they definitely were. It just about sent me over the edge. Given how he was searching for different ways to himself communicate his need to me, I think he may very well have been reflecting on this a while himself. That’s some great work on his part.

This is what happens in a minimal or non-verbal situation where alternative, more technological communication systems don’t fit into the equation yet. If there’s one truth in autism it’s that “behavior is communication”, and it’s up to us to learn how to become Sherlock Holmes and interpret and recognize the patterns not only in the language but in their entire environment, and constantly look for ways to understand someone and be understood by them.

The J-Man and I managed somehow to do that here, and I’m proud of us for it.

Comments

without knowing all the details, and I’ve said this on twitter, I would never had guessed that it was the toothpaste. But then, I usually have a problem with too much toothpaste, which I just spit out.

There are times when things that haven’t “gone right” bother me enough for me to go back and redo in order to “get right”. Like making sure things are in the right spot and in the right position. It just feels right that things are in a certain way, and that’s comforting.

Sherlock Holmes indeed – and the physician who served as the role model for Holmes. A wonderful example of the diagnostic process, as well as the love and empathy and partnership that makes you such amazing parents.

@Corina – Really appreciate your insights. Wanted to say that I’ve learned a lot from your tweets and blog. (Y’all go follow @CorinaBecker on Twitter.) Your comment here helps affirm that we’re looking at this from the right perspective. We try very hard to put ourselves in his position and to see things as he might experience them, but obviously that’s very hard if not largely impossible to do. So we need all the input we can get! I had never really thought about the comfort of redoing until thinking about all this along with your comment. This really helps. Thanks!

@JoyMama – Thank you too! I’m thinking that pattern recognition is a more highly developed trait in many of our families for a reason. 🙂 If nothing else, stubbornness counts for a lot. We’re slowly mending, but the coughs, cold, and runny noses still live on.

@Jay – There’s also a fair amount of discussion here and there about Sherlock Holmes being on the spectrum. Perhaps an interesting thought exercise, but I haven’t read any of those books in ages. I wish we were able to think through these things more analytically and systematically. This was more a blinding flash of insight I think than something arrived at as linearly as I may have implied. I guess all the thinking about it does at least pave the way for those insights to come than they otherwise would, though. Necessity is the mother of all kinds of things. We’re just so tired and emotional when things get like this that it’s often all reactive and very little proactive. And you rock too. 🙂

Aw, well thank you. I try very hard to be a help for people to understand autism. I can’t say that I always get it right, but I try to put myself in another autistic’s situation and think “what would I be experiencing right now? What am I trying to communicate by doing this?”

As I’ve said, sometimes I get it right, sometimes I don’t. I think that it’s worth it if I’m able to produce even just a little bit of understanding. I also really appreciate it when people are trying to figure out the autistic side of things, rather than just seeing a “bad autism” behaviour and trying to stop it.

The “getting things right” applies to many situations. I know that I had trouble (and still do) getting to sleep at night because of the shadows that things in my room made. Each night, I go around my room, tucking things in, rearranging items and making sure things are where they need to be. This has reduced a bit for me recently, because I’ve taken to using LED christmas lights as a nightlight, which produces an illuminating glow as opposed to harsh shadow-causing light, and because I’ve gotten laser eye surgery, so I can clearly see things instead of my mind imagining what things are.
But I still tidy before bed. It is comforting, anxiety-reducing, and not to mention, helps to keep my room a resemblance of clean.

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